Ka. Brensing et al., Long term outcome after transjugular intrahepatic portosystemic stent-shunt in non-transplant cirrhotics with hepatorenal syndrome: a phase II study, GUT, 47(2), 2000, pp. 288-295
Background-Recent small studies on hepatorenal syndrome (MRS) indicate some
clinical benefit after transjugular intrahepatic portosystemic stent-shunt
(TIPS) but sufficient long term data are lacking.
Aim-We studied prospectively feasibility, safety, and long term survival af
ter TIPS in 41 non-transplantable cirrhotics with HRS (phase II study).
Patients and methods-MRS was diagnosed using current criteria (severe (type
I) MRS, n=21; moderate (type II) HRS, n=20). Thirty one patients (14 type
I, 17 type II) received TIPS (8-10 mm) while advanced liver failure exclude
d shunting in 10. During follow up (median 24 months) we analysed renal fun
ction and survival (Kaplan-Meier).
Results-TIPS markedly reduced the portal pressure gradient (21 (5) to 13 (4
) nun Mg (mean (SD)); p<0.001) with one procedure related death (3.2%). Ren
al function deteriorated without TIPS but improved (p<0.001) within two wee
ks after TIPS (creatinine clearance 18 (15) to 48 (42) ml/min; sodium excre
tion 9 (16) to 77 (78) mmol/24 hours) and stabilised thereafter. Following
TIPS, three, six, 12, and 18 month survival rates were 81%, 71%, 48%, and 3
5%, respectively. As only 10% of non-shunted patients survived three months
, total survival rates were 63%, 56%, 39%, and 29%, respectively. Multivari
ate Cox regression analysis revealed bilirubin (p<0.001) and HRS type (p<0.
05) as independent survival predictors after TIPS.
Conclusions-TIPS provides long term renal function and probably survival be
nefits in the majority of non-transplantable cirrhotics with HRS. These dat
a warrant controlled trials evaluating TIPS in the management of HRS.